站立位马匹中未校准的脉搏轮廓心输出量监测仪FloTrac/Vigileo与热稀释法的对比评估。
Evaluation of the non-calibrated pulse contour cardiac output monitor FloTrac/Vigileo against thermodilution in standing horses.
作者信息
Kutter Annette P N, Bettschart-Wolfensberger Regula, Schwarzwald Colin C, Portier Karine G, Ringer Simone K
机构信息
Section of Anaesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
Clinic for Equine Internal Medicine, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
出版信息
Vet Anaesth Analg. 2016 Mar;43(2):153-62. doi: 10.1111/vaa.12281. Epub 2015 Jun 11.
OBJECTIVE
To evaluate the non-calibrated, minimally invasive cardiac output (CO) monitor FloTrac/Vigileo (FloTrac) against thermodilution (TD) CO in standing horses.
STUDY DESIGN
Prospective, experimental trial.
ANIMALS
Nine adult horses weighing a median (range) of 535 (470-602) kg.
METHODS
Catheters were placed in the right atrium, pulmonary artery and carotid artery under local anaesthesia. CO was measured 147 times by TD and FloTrac and indexed to body weight. Changes in CO were achieved with romifidine or xylazine and dobutamine constant rate infusions. Bland-Altman analysis, concordance and polar plot analysis were used to assess agreement and ability to track changes in CO.
RESULTS
Mean ± standard deviation COTD of 48 ± 16 mL kg(-1) minute(-1) (range: 19-93 mL kg(-1) minute(-1) ) and mean COF loTrac of 9 ± 3 mL kg(-1) minute(-1) (range: 5-21 mL kg(-1) minute(-1) ) were measured. Low agreement with a large mean bias of 39 mL kg(-1) minute(-1) and wide limits of agreement of 8-70 mL kg(-1) minute(-1) were found. The percentage error of 108% and precision of TD of ± 18% resulted in an estimated precision of FloTrac of ± 106%. Comparison of changes in COF loTrac with changes in COTD gave a concordance rate of 52% in the four-quadrant plot, and a mean polar angle of -11° with radial limits of agreement of ± 61 ° in the polar plot. Mean arterial pressure (MAP) and COF loTrac were positively correlated (r = 0.5, p < 0.0001). No correlation of MAP with COTD was observed.
CONCLUSIONS AND CLINICAL RELEVANCE
The FloTrac system, originally designed for use in humans, neither measured absolute CO in standing horses accurately nor tracked relative changes in CO measured by TD correctly. The false dependence of COF loTrac on arterial blood pressure further discourages the use of this technique in horses.
目的
在站立位马匹中，将非校准的微创心输出量（CO）监测仪FloTrac/Vigileo（FloTrac）与热稀释法（TD）测定的心输出量进行评估对比。
研究设计
前瞻性实验性试验。
动物
9匹成年马，体重中位数（范围）为535（470 - 602）千克。
方法
在局部麻醉下，将导管分别置于右心房、肺动脉和颈动脉内。通过TD和FloTrac测量心输出量147次，并将其与体重进行指数化处理。使用罗米芬或赛拉嗪以及多巴酚丁胺恒速输注来实现心输出量的变化。采用Bland - Altman分析、一致性分析和极坐标图分析来评估一致性以及跟踪心输出量变化的能力。
结果
测得热稀释法心输出量（COTD）均值±标准差为48 ± 16 mL·kg⁻¹·min⁻¹（范围：19 - 93 mL·kg⁻¹·min⁻¹），FloTrac心输出量（COFloTrac）均值为9 ± 3 mL·kg⁻¹·min⁻¹（范围：5 - 21 mL·kg⁻¹·min⁻¹）。发现两者一致性较低，平均偏差较大，为39 mL·kg⁻¹·min⁻¹，一致性界限较宽，为8 - 70 mL·kg⁻¹·min⁻¹。热稀释法的百分比误差为108%，精度为±18%，由此估计FloTrac的精度为±106%。在四象限图中，将COFloTrac的变化与COTD的变化进行比较，一致性率为52%；在极坐标图中，平均极角为 - 11°，径向一致性界限为±61°。平均动脉压（MAP）与COFloTrac呈正相关（r = 0.5，p < 0.0001）。未观察到MAP与COTD之间存在相关性。
结论及临床意义
最初设计用于人类的FloTrac系统，既不能准确测量站立位马匹的绝对心输出量，也不能正确跟踪热稀释法测定的心输出量的相对变化。COFloTrac对动脉血压的错误依赖性进一步阻碍了该技术在马匹中的应用。
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